Search Results for "acupuncture"

Mar 11 2010

Acupuncture Does Not Work for IVF

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Acupuncture is a so-called complementary and alternative medicine (CAM) modality I frequently tackle because it often provides excellent  teaching points on the relationship between science and the practice of medicine. My reading of the literature is that acupuncture is highly implausible and the evidence does not support its efficacy for any indication.

And yet it is one of the more popular CAM modalities (although still a small phenomenon – only 6% of Americans have ever used it), especially in its penetration of hospitals and academia. There is a great deal of misinformation out there about acupuncture, and this seems to garner the most attention from naive physicians.

In vitro fertilization (IVF) is one of the applications of acupuncture that has been most touted by proponents. The evidence for any positive effect from acupuncture for IVF, however, has been consistent with no effect. By this I mean that there are poor quality studies with mixed results, but trending positive (as poor quality studies tend to do), especially in China and other nations culturally predisposed to acupuncture, but the better designed studies tend to be negative.

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20 responses so far

Mar 03 2010

Acupuncture for Depression

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One of the basic principles of science-based medicine is that a single study rarely tells us much about any complex topic. Reliable conclusions are derived from an assessment of basic science (i.e prior probability or plausibility) and a pattern of effects across multiple clinical trials. However the mainstream media generally report each study as if it is a breakthrough or the definitive answer to the question at hand. If the many e-mails I receive asking me about such studies are representative, the general public takes a similar approach, perhaps due in part to the media coverage.

I generally do not plan to report on each study that comes out as that would be an endless and ultimately pointless exercise. But occasionally focusing on a specific study is educational, especially if that study is garnering a significant amount of media attention. And so I turn my attention this week to a recent study looking at acupuncture in major depression during pregnancy. The study concludes:

The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in standard depression treatments of similar length and could be a viable treatment option for depression during pregnancy.

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28 responses so far

May 12 2009

More on Acupuncture

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I am covering the in-patient service this month and so I am more busy than usual. I am trying to keep my blogging schedule without change, but it’s challenging, so forgive me if I occasionally miss a post or I am late.

For that reason, for my post today I am simply going to respond to a comment on my recent post on acupuncture and migraines. In response to this, frequent commenter, Sonic, wrote:

The conclusion that acupuncture does not work does not coincide with the evidence presented.

From the 2009 Cocrane review:

“Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment.”

This implies that acupuncture is a safe and effective treatment compared to the “proven” prophylactic drug treatment.

A drug company could go to the FDA with a study that showed their treatment to be better than the existing proven treatment and get approval based on that fact.

The conclusion that it is possible that the exact placement of the needles may not be as important as thought, does not invalidate the therapy.

Just because there might be a mistake in exactly how something works does not invalidate that it does work. The studies quoted would indicate that acupuncture works as well as or better than any other current therapy.

There is nothing in the evidence to indicate that the therapy did not work better than any existing therapy and better than doing nothing.

The fact that something works better than the proven therapy means that it works.

To conclude otherwise is to misread the evidence as presented.

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35 responses so far

May 07 2009

Obama’s Health Initiative – Acupuncture for Migraine

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It must be tough being a highly visible politician – specifically taking questions from the public. You can get hit with highly technical questions in any area, often posed by someone with a narrow agenda and a great deal of information with which they can plan rhetorical mines. I don’t expect politicians to have all the technical details for any such issue at their fingertips. Experienced politicians, however, have learned how to handle such situations – the first rule of which is not to pull facts out of your butt.

George Bush’s most famous such gaffe, in my opinion, is when he said that the “jury is still out” on the question of evolution. Right – only greater than 98% of all scientists agree that evolution is a scientific fact, but we’re still waiting on the other 1% or so of hold outs.

Obama is not likely to get tripped up on the evolution issue, but he is vulnerable when it comes to science and medicine. Unscientific medical modalities and practitioners have found allies on both sides of the political aisle. The impending health care reform has also mobilized the CAM (complementary and alternative medicine) troops who are trying to twist the health care agenda to serve pseudoscience.

At a recent town meeting Obama received the following question and gave the following answer:

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17 responses so far

Nov 17 2008

Through the Looking Glass of Acupuncture Research

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Clinical research tends to follow a certain arc: first smaller and preliminary studies are done to see if there is a potential for a new treatment or approach, then larger and more tightly designed studies are done exploring the relevant research questions, and finally large, double-blind, placebo-controlled consensus trials are completed and the basic question of efficacy is settled.

In scientific jargon we often talk about the null hypothesis, the hypothesis that a new claim is not true, or in the context of medicine that a new treatment does not work. The question for a study is framed as follows: does the data support the rejection of the null hypothesis. This is not a subtle or unimportant distinction, it puts the burden of proof on demonstrating the positive new claim – that a treatment works. Unless the data compels us to reject the null hypothesis, it is retained as the default conclusion. Therefore, in these large and well-controlled trials, if the treatment does not work consistently and both clinically and statistically significantly better than placebo, we do not reject the null hypothesis. In practice we conclude that the treatment does not work and it is appropriately discarded in favor of better treatments or new ideas.

Unless of course you live in the alternate universe of acupuncture research (or more generally that of complementary and alternative medicine – CAM).

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6 responses so far

Sep 04 2008

An Acupuncture Debate

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Recently I was invited to write my views on acupuncture for a website called Opposing Views. I pre-published (with permission) my side of the debate on “Does Acupuncture Work” here at NeuroLogica. Taking the pro-acupuncture side is Bill Reddy – his profile states that he is “currently serving on the Executive Committee of the American Association of Acupuncture and Oriental Medicine.”

The format of the website allows for moderated comments, which are intended to allow for a written debate with the two sides. Here are my responses to the first round of arguments.

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18 responses so far

Aug 29 2008

Another Worthless Acupuncture Study

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Comming (by coincidence) on the heels of my recent blog entry on why I am skeptical of acupuncture, another major acupuncture study has just been published. This study looked at acupuncture for headaches, and was published in a major headache journal – Cephalalgia. The media, in typical fashion, gets the bottom line wrong, declaring: “Acupuncture may ease chronic headache pain.”

It took me about 10 seconds (literally) to realise that this study was utterly worthless. That is because it is unblinded – meaning that both subjects and physicians knew which patients were getting acupuncture and which were not, which further means that there is no way to know if the measured effect was all placebo.

Still I read the study to analyze it more carefully. My fellow skeptical blogger, Orac, has already beaten me to the punch, however, in deconstructing this study.  I will not, therefore, repeat what he has written. He correctly points out the major flaws in the study – that it is not blinded, there is no sham-acupuncture group, and it is not fully randomized. He also points out many of the minor flaws, such as not distinguishing among the various headache types, some self-selection in the non-randomized group, and the reliance on subject memory (rather than real-time diaries) for data collection. Read his entry for a more detailed discussion of these fatal flaws.

What I want to discuss in more detail here is the very fact that this study was done in the first place. What purpose did it fill?

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8 responses so far

Aug 25 2008

Why I Am Skeptical of Acupuncture

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Acupuncture is the practice of placing very thin needles through the skin in specific locations of the body for the purpose of healing and relief of symptoms. This practice is several thousand years old and is part of Traditional Chinese Medicine. As practiced today it is often combined with other interventions, such as sending a small current of electricity through the needles or burning herbs on the acupuncture points (a practice called moxibustion).

Acupuncture has recently been transplanted to the West, riding the wave of tolerance for unscientific treatment practices marketed as “complementary and alternative medicine.” While advocates have been successful at pushing acupuncture into the culture, the scientific medical community has still not accepted the practice as a legitimate scientific practice. I count myself among those extremely skeptical of acupuncture. I outline here the reasons for my continued skepticism.

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45 responses so far

Dec 10 2007

Acupuncture and Misdirection

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Yet another study has been published allegedly showing that “acupuncture works.” The study is published in the journal Anesthesiology and looks at post operative nausea and vomiting. There are many problems, however, with the conclusions drawn from the study an it does not support the claims of acupuncture.

The study also represents a big problem with the complementary and alternative medicine (CAM) literature and movement – that it uses ultimately fictional categories of types of treatment and then blurs those lines in an attempt to promote the category. In fact the entire category of CAM itself is a political fiction (there are no underlying principles that define CAM as a category) and CAM proponents deliberately try to include within the CAM category things like nutrition and physical therapy (which are evidence-based and definitely not CAM) as a way of legitimizing the category. Typically proponents will extrapolate wildly from – nutritional therapy A works for disease B, therefore nutrition works, and therefore CAM works, since nutrition is part of CAM.

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14 responses so far

Sep 25 2007

Does Acupuncture Work or Not?

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Acupuncture is a complex “alternative” modality because something physical is actually happening – thin needles are being stuck through the skin and manipulated. So it is therefore not impossible that a physiological response is happening. It is much easier to comment on things like homeopathy and therapeutic touch where literally nothing physical is happening and the plausibility for any benefit is therefore zero. So if I try to answer the question in my title, much explanation and qualifications are required. To answer this question – does acupuncture work? – my current best answer based upon available evidence is a qualified no. This answer is not changed by the most recent study of acupuncture that is being touted by the press as evidence that acupuncture works. (Here is the original study, but a subscription is required.)

Let’s first look at this study, which was a German study of acupuncture for back pain. Dr. Heinz Endres studied 1,100 randomized patients with three treatment arms. The first received standard therapy – massage, anti-inflammatories, and heating pads. The second received acupuncture, and the third received sham acupuncture where the needles were inserted but not deeply, and not manipulated, and not in traditional acupuncture points. The study found 47% improvement in the acupuncture group, 44% in the sham acupuncture, and 27% in the standard therapy group after 6 months.

This single study, even taken just by itself, falls far short of demonstrating that acupuncture works. And of course we have to place it in the context of plausibility and the entire acupuncture literature. We also have to identify appropriate sub-questions.

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31 responses so far

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